Basic Information
| Provider Information | |||||||||
| NPI: | 1447494943 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY SERVICE CENTERS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2960 ROOSEVELT BLVD | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337601952 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2960 ROOSEVELT BLVD | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337601952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275310482 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2009 | ||||||||
| LastUpdateDate: | 04/28/2009 | ||||||||
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| AuthorizedOfficialLastName: | MONAHAN | ||||||||
| AuthorizedOfficialFirstName: | MARY JO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7275310482 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | ISW 4781 | FL | Y | Agencies | Community/Behavioral Health |
No ID Information.